This study investigates peer interaction and peer support for parentally bereaved children and adolescents. Using data from an extensive study of bereaved families in southeastern Michigan, previously transcribed semistructured interviews on peer relationships from a sample of 35 parentally bereaved children aged 6 to 15 were qualitatively analyzed using the constant comparative method. This analysis explores peer interaction in the context of parental loss, revealing the nearly ubiquitous desire of bereaved children to be perceived as "normal" and maintain their social life as it was before the death, the avoidance of bereavement-related peer interaction, the nature of and possible reasons for the relative lack of peer support, deliberately hurtful peer behavior, the multiple functions of peer support, and the value of close friends in bereavement.
Objective: Evidence is mixed regarding whether relaxation-induced anxiety (RIA) impedes relaxation training (RT) efficacy. Unlike past studies that averaged RIA across sessions, we examined peak RIA, change in RIA level across sessions, and timing of peak RIA with outcome. Method: This was a secondary analysis of Borkovec et al. (2002). Forty-one GAD participants were assigned randomly to CBT (n = 22) or BT (n = 19). Both treatments contained RT and RIA ratings within 13/14 sessions. Analyses used generalized additive mixed models, which accounted for longitudinal nonindependence and examined non-linear trajectories of change. Results: All participants improved significantly regardless of RIA. Average change trajectory of RIA level did not predict outcome. Instead, lower peak RIA predicted fewer GAD symptoms at post-treatment and greater likelihood to continue to improve during follow-up. Also, timing of peak was important. Whereas lower peak early in therapy did not predict outcome, lower peak during the last third of treatment did. Peak RIA’s effect was neither accounted for by baseline symptom severity, treatment condition, comorbidity, nor by preceding or concurrent anxiety symptom change. Conclusions: People with consistently low peak RIA and/or who fully habituate to RIA by the end of therapy respond optimally to relaxation-based treatments.
This study investigates peer interaction and peer support for parentally bereaved children and adolescents. Using data from an extensive bereavement study, transcribed semistructured interviews on peer relationships from a sample of 35 parentally bereaved children aged 6 to 15 were systematically coded. Exploratory dimensions of inquiry included incidence counts of teasing, peer interaction regarding bereavement, and preference for interaction, among 12 other dimensions. Hypotheses related to age, gender, and parental death type (anticipated vs. sudden) differences on peer support reception were also tested. Major findings included the following: 71.4% of the sample received support from peers, although 71.4% preferred not to have bereavement-related peer interaction. A significantly greater percentage of females versus males experienced peer support and a positive emotional response, and a significantly greater percentage of children bereaved by anticipated deaths versus sudden deaths had received bereavement-related peer interaction and support. No significant differences were found between younger and older children.
Theories of cognitive therapy have long proposed that those with generalized anxiety disorder (GAD) have inaccurate expectations. By challenging them with objective evidence, symptoms are thought to decrease. To test these premises, this study used ecological momentary assessment (EMA) during the Worry Outcome Journal (WOJ) treatment to determine the percentage of GAD worries that did not come true. We then analyzed the association between participants' untrue worry percentages and GAD symptom change across treatment. Twenty-nine participants with GAD recorded worries when prompted for 10 days, reviewed them online nightly, and tracked their worry outcomes across 30 days. These recordings were then coded by independent raters. Analyses applied bias-correct bootstrapping path analysis on slopes extracted from longitudinal linear mixed models. Primary results revealed that 91.4% of worry predictions did not come true. Higher percentages of untrue worries significantly predicted lower GAD symptoms after treatment, as well as a greater slope of symptom reduction from pre-to post-trial. Participants' average expected likelihoods of worries coming true were much greater than actual observed likelihoods. The most common percentage of untrue worries per person was 100%. Thus, worries in those with GAD were mostly inaccurate. Greater evidence of this inaccuracy predicted greater improvement in treatment. As theorized, disconfirming false expectations may significantly contribute to treatment's effect. Keywords generalized anxiety disorder; worry; cognitive therapy; worry outcome monitoring; selfmonitoring Numerous efficacy studies have established the power of cognitive behavioral therapies (CBTs), evincing moderate to large effect sizes (Butler, Chapman, Forman, & Beck, 2006; Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012) and marking many as empirically supported treatments (ESTs; Chambless & Ollendick, 2001). Yet less research has examined how these therapies create change. Many scholars have argued that we should prioritize the study of treatment predictors, processes, and targets, elucidating the factors responsible for There are no conflicts of interest or financial disclosures related to this work.
This study was a secondary analysis of LaFreniere and Newman (2016), a randomized controlled trial comparing two ecological momentary interventions (EMIs) for generalized anxiety disorder (GAD): The worry outcome journal (WOJ) and thought log (TL). We predicted that higher thought-related distress would be a mediator by which higher uncontrollability beliefs (UB) would hinder the efficacy of the WOJ, but not the TL. Fifty-one undergraduates who met GAD criteria underwent one of the EMIs for 10 days. WOJ users tracked worries, associated distress, interference, expected outcome probabilities, and whether their worries came true four times/day. TL users tracked general thoughts, associated distress, and interference four times/day. Bootstrapping path analysis was used to analyze moderated mediation models. Higher UB predicted higher thought-related distress for both EMIs. Higher UB also predicted reduced efficacy of the WOJ at post-trial and of both EMIs at 30-day follow-up. However, for WOJ users, when higher initial UB levels predicted higher thought-related distress early in treatment, participants reported greater levels of worry at post-trial and follow-up. In contrast, UB’s effect on the TL group at post-trial and follow-up was not mediated by early distress. Thought-related distress appears to be a mechanism by which UB impedes the WOJ intervention.
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